AIM: To predict the re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy(ES) bleeding.METHODS: Over a 15-year period, data from 161 patients with delayed post-ES bleeding were retrospecti...AIM: To predict the re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy(ES) bleeding.METHODS: Over a 15-year period, data from 161 patients with delayed post-ES bleeding were retrospectively collected from a single medical center. To identify risk factors for re-bleeding after initial successful endoscopic hemostasis, parameters before, during and after the procedure of endoscopic retrograde cholangiopancreatography were analyzed. These included age, gender, blood biochemistry, comorbidities, endoscopic diagnosis, presence of periampullary diverticulum, occurrence of immediate postES bleeding, use of needle knife precut sphincterotomy, severity of delayed bleeding, endoscopic features on delayed bleeding, and type of endoscopic therapy.RESULTS: A total of 35 patients(21.7%) had rebleeding after initial successful endoscopic hemostasis for delayed post-ES bleeding. Univariate analysis revealed that malignant biliary stricture, serum bilirubin level of greater than 10 mg/d L, initial bleeding severity, and bleeding diathesis were significant predictors of rebleeding. By multivariate analysis, serum bilirubin level of greater than 10 mg/d L and initial bleeding severity remained significant predictors. Re-bleeding was controlled by endoscopic therapy in a single(n = 23) or multiple(range, 2-7; n = 6) sessions in 29 of the 35 patients(82.9%). Four patients required transarterial embolization and one went for surgery. These five patients had severe bleeding when delayed post-ES bleeding occurred. One patient with decompensated liver cirrhosis died from re-bleeding.CONCLUSION: Re-bleeding occurs in approximately one-fifth of patients after initial successful endoscopic hemostasis for delayed post-ES bleeding. Severity of initial bleeding and serum bilirubin level of greater than 10 mg/d L are predictors of re-bleeding.展开更多
BACKGROUND Peptic ulcer disease(PUD)remains a significant healthcare burden,contributing to morbidity and mortality worldwide.Despite advancements in therapies,its prevalence persists,particularly in regions with wide...BACKGROUND Peptic ulcer disease(PUD)remains a significant healthcare burden,contributing to morbidity and mortality worldwide.Despite advancements in therapies,its prevalence persists,particularly in regions with widespread nonsteroidal antiinflammatory drugs(NSAIDs)use and Helicobacter pylori infection.AIM To comprehensively analyse the risk factors and outcomes of PUD-related upper gastrointestinal(GI)bleeding in Pakistani population.METHODS This retrospective cohort study included 142 patients with peptic ulcer bleeding who underwent upper GI endoscopy from January to December 2022.Data on demographics,symptoms,length of stay,mortality,re-bleed,and Forrest classification was collected.RESULTS The mean age of patients was 53 years,and the majority was men(68.3%).Hematemesis(82.4%)and epigastric pain(75.4%)were the most common presenting symptoms.Most patients(73.2%)were discharged within five days.The mortality rates at one week and one month were 10.6%and 14.8%,respectively.Re-bleed within 24 h and seven days occurred in 14.1%and 18.3%of patients,respectively.Most ulcers were Forrest class(FC)Ⅲ(72.5%).Antiplatelet use was associated with higher mortality at 7 and 30 d,while alternative medications were linked to higher 24-hour re-bleed rates.NSAID use was associated with more FCⅢulcers.Re-bleed at 24 h and 7 d was strongly associated with one-week or one-month mortality.CONCLUSION Antiplatelet use and rebleeding increase the risk of early mortality in PUD-related upper GI bleeding,while alternative medicines are associated with early rebleeding.展开更多
目的探讨内镜下改良“三明治夹心法”对重度食管静脉曲张(esophageal varices,EV)的治疗效果及对早期再出血的影响。方法选取2018年4月至2021年4月新余市人民医院收治的60例重度EV患者作为研究对象,采用摸球法分为对照组与观察组,每组3...目的探讨内镜下改良“三明治夹心法”对重度食管静脉曲张(esophageal varices,EV)的治疗效果及对早期再出血的影响。方法选取2018年4月至2021年4月新余市人民医院收治的60例重度EV患者作为研究对象,采用摸球法分为对照组与观察组,每组30例。对照组采用“三明治夹心法”(聚桂醇+组织胶+聚桂醇)治疗,观察组采用改良“三明治夹心法”(0.9%氯化钠溶液+组织胶+0.9%氯化钠溶液)治疗。比较两组临床疗效、症状积分、生命质量综合评定问卷(generic quality of life inventory-74,GQOLI-74)评分、复发率、出血率及并发症发生率。结果观察组治疗总有效率为96.67%,高于对照组的73.33%,差异有统计学意义(P<0.05);治疗后,观察组腹胀、恶心、食欲减退、呕吐评分均低于对照组,躯体功能、心理功能、社会功能、物质生活状态评分均高于对照组,差异有统计学意义(P<0.05);治疗后随访1年,观察组再出血率、复发率均为3.33%,均低于对照组的33.33%、30.00%,差异有统计学意义(P<0.05);治疗后6个月,观察组并发症发生率为6.67%,低于对照组的33.33%,差异有统计学意义(P<0.05)。结论采用改良“三明治夹心法”治疗重度EV患者效果显著,能有效降低患者复发率和出血率,减少并发症的发生,提高患者生命质量,改善患者临床不良症状。展开更多
文摘AIM: To predict the re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy(ES) bleeding.METHODS: Over a 15-year period, data from 161 patients with delayed post-ES bleeding were retrospectively collected from a single medical center. To identify risk factors for re-bleeding after initial successful endoscopic hemostasis, parameters before, during and after the procedure of endoscopic retrograde cholangiopancreatography were analyzed. These included age, gender, blood biochemistry, comorbidities, endoscopic diagnosis, presence of periampullary diverticulum, occurrence of immediate postES bleeding, use of needle knife precut sphincterotomy, severity of delayed bleeding, endoscopic features on delayed bleeding, and type of endoscopic therapy.RESULTS: A total of 35 patients(21.7%) had rebleeding after initial successful endoscopic hemostasis for delayed post-ES bleeding. Univariate analysis revealed that malignant biliary stricture, serum bilirubin level of greater than 10 mg/d L, initial bleeding severity, and bleeding diathesis were significant predictors of rebleeding. By multivariate analysis, serum bilirubin level of greater than 10 mg/d L and initial bleeding severity remained significant predictors. Re-bleeding was controlled by endoscopic therapy in a single(n = 23) or multiple(range, 2-7; n = 6) sessions in 29 of the 35 patients(82.9%). Four patients required transarterial embolization and one went for surgery. These five patients had severe bleeding when delayed post-ES bleeding occurred. One patient with decompensated liver cirrhosis died from re-bleeding.CONCLUSION: Re-bleeding occurs in approximately one-fifth of patients after initial successful endoscopic hemostasis for delayed post-ES bleeding. Severity of initial bleeding and serum bilirubin level of greater than 10 mg/d L are predictors of re-bleeding.
文摘BACKGROUND Peptic ulcer disease(PUD)remains a significant healthcare burden,contributing to morbidity and mortality worldwide.Despite advancements in therapies,its prevalence persists,particularly in regions with widespread nonsteroidal antiinflammatory drugs(NSAIDs)use and Helicobacter pylori infection.AIM To comprehensively analyse the risk factors and outcomes of PUD-related upper gastrointestinal(GI)bleeding in Pakistani population.METHODS This retrospective cohort study included 142 patients with peptic ulcer bleeding who underwent upper GI endoscopy from January to December 2022.Data on demographics,symptoms,length of stay,mortality,re-bleed,and Forrest classification was collected.RESULTS The mean age of patients was 53 years,and the majority was men(68.3%).Hematemesis(82.4%)and epigastric pain(75.4%)were the most common presenting symptoms.Most patients(73.2%)were discharged within five days.The mortality rates at one week and one month were 10.6%and 14.8%,respectively.Re-bleed within 24 h and seven days occurred in 14.1%and 18.3%of patients,respectively.Most ulcers were Forrest class(FC)Ⅲ(72.5%).Antiplatelet use was associated with higher mortality at 7 and 30 d,while alternative medications were linked to higher 24-hour re-bleed rates.NSAID use was associated with more FCⅢulcers.Re-bleed at 24 h and 7 d was strongly associated with one-week or one-month mortality.CONCLUSION Antiplatelet use and rebleeding increase the risk of early mortality in PUD-related upper GI bleeding,while alternative medicines are associated with early rebleeding.
文摘目的 比较内镜下套扎治疗与内镜下组织胶注射用于肝硬化胃静脉曲张出血二级预防的疗效及安全性。方法 选择2017年1月至2019年12月因肝硬化胃静脉曲张出血入住复旦大学附属中山医院,行食管胃曲张静脉内镜下套扎治疗的患者(套扎组),另选择同期行内镜下组织胶注射治疗的患者(组织胶组),通过倾向性评分匹配,两组分别纳入59例。采用单因素与多因素Cox比例风险回归模型分析食管胃静脉曲张再出血影响因素。绘制Kaplan-Meier曲线,比较两组患者再出血及生存情况。结果 套扎组与组织胶组患者食管胃静脉曲张根除率差异无统计学意义(83.05%vs 79.66%,P=0.778);套扎组根除静脉曲张所须中位内镜治疗次数(2 vs 3次,P=0.017)及平均组织胶用量明显少于组织胶组(0.70 mL vs 2.67 mL,P<0.001)。多因素Cox回归分析显示,门体分流是食管胃静脉曲张再出血的危险因素(HR=3.14,95%CI 1.02~9.68,P=0.046),内镜下套扎是预防再出血的保护因素(HR=0.25,95%CI 0.08~0.71,P=0.010)。相较于内镜下组织胶注射,内镜下套扎不增加患者2年食管胃静脉曲张再出血风险(18.69%vs 36.29%,P=0.067)与死亡风险(1.69%vs 3.39%,P=1.000)。相较于内镜下组织胶注射,经内镜下套扎治疗后,GOV1型患者食管胃静脉曲张再出血风险较低(0 vs 40.27%,P=0.012),GOV2型患者再出血风险(13.27%vs 34.16%,P=0.056)呈降低趋势。结论 内镜下套扎治疗对食管胃静脉曲张的根除率较高,且并不增加再出血、死亡等事件风险,可作为胃静脉曲张出血患者的二级预防手段。
文摘目的探讨内镜下改良“三明治夹心法”对重度食管静脉曲张(esophageal varices,EV)的治疗效果及对早期再出血的影响。方法选取2018年4月至2021年4月新余市人民医院收治的60例重度EV患者作为研究对象,采用摸球法分为对照组与观察组,每组30例。对照组采用“三明治夹心法”(聚桂醇+组织胶+聚桂醇)治疗,观察组采用改良“三明治夹心法”(0.9%氯化钠溶液+组织胶+0.9%氯化钠溶液)治疗。比较两组临床疗效、症状积分、生命质量综合评定问卷(generic quality of life inventory-74,GQOLI-74)评分、复发率、出血率及并发症发生率。结果观察组治疗总有效率为96.67%,高于对照组的73.33%,差异有统计学意义(P<0.05);治疗后,观察组腹胀、恶心、食欲减退、呕吐评分均低于对照组,躯体功能、心理功能、社会功能、物质生活状态评分均高于对照组,差异有统计学意义(P<0.05);治疗后随访1年,观察组再出血率、复发率均为3.33%,均低于对照组的33.33%、30.00%,差异有统计学意义(P<0.05);治疗后6个月,观察组并发症发生率为6.67%,低于对照组的33.33%,差异有统计学意义(P<0.05)。结论采用改良“三明治夹心法”治疗重度EV患者效果显著,能有效降低患者复发率和出血率,减少并发症的发生,提高患者生命质量,改善患者临床不良症状。
